Cumulative childhood trauma exposure and depressive and anxiety symptoms among Kenyan adolescents: A multilevel school-based study

Adolescents in low- and middle-income countries experience a high burden of depression and anxiety, often in the context of exposure to multiple childhood traumas including abuse, neglect, and household dysfunction. This study examined how cumulative childhood trauma exposure (ACEs) and perceived social support relate to depressive and anxiety symptoms among Kenyan secondary school students using a large, school-based dataset. A cross-sectional secondary analysis was conducted using survey data from 15,177 students in 23 secondary schools. Depressive (PHQ-8) and anxiety (GAD-7) symptoms were regressed on a cumulative ACE index (ACEStotal) and perceived social support (MSPSStotal) using multilevel linear models with random school intercepts, adjusting for age, gender, and school form. Single-level ordinary least squares models with cluster-robust standard errors were estimated as sensitivity analyses. Intraclass correlations were modest (ICCPHQ = .024; ICCGAD = .015). Higher ACEStotal predicted higher PHQtotal and GADtotal (b ≈ 0.40–0.46, p < .001), whereas MSPSStotal showed no independent association with either outcome in adjusted models. Sensitivity analyses yielded a similar pattern of findings. Cumulative childhood trauma is a strong and consistent correlate of depressive and anxiety symptoms among Kenyan secondary school students. These findings suggest that trauma-informed mental health services in low- and middle-income settings should prioritize young people exposed to multiple traumas and consider integrating trauma-informed screening and stepped-care pathways within school-linked services.